Or. Admin. Code § 436-060-0155 - Penalty to Worker for Untimely Processing
(1)
General. If the insurer unreasonably delays or unreasonably
refuses to pay compensation, attorney fees or costs, or unreasonably delays
acceptance or denial of a claim:
(a) The
director may require the insurer to pay:
(A) A
penalty, payable to the worker, of up to 25 percent of the amounts then due,
determined by the matrix attached to these rules in Appendix "B." When there
are no "amounts then due" upon which to assess a penalty, no penalty will be
issued under this rule; and
(b) For the purpose of this rule, and the
matrix attached to these rules in Appendix "B," a "violation" is:
(A) The late payment or the nonpayment of any
single payment due;
(B) A
continuous underpayment, such as with yearly cost of living increases for
temporary disability compensation. In the case of a continuous underpayment,
all prior underpayments will be considered as one violation, regardless of when
the first underpayment occurred; or
(C) The late issuance of an acceptance or
denial notice under OAR
436-060-0140(2).
(2)
Requests for penalties
and attorney fees. Requests for penalties and attorney fees under this
rule must:
(a) Be made in writing;
(b) State, in the request, what benefits have
been delayed or remain unpaid; and
(c) Be mailed or delivered to the division
within 180 days of the date of the alleged violation. For the purpose of this
rule, the date of the alleged violation is:
(A) For the late payment or nonpayment of any
single payments, the date payment was due;
(B) For a continuous underpayment, the date
of the last underpayment; or
(C)
For a late issuance of an acceptance or denial notice, the date the notice was
due under OAR 436-060-0140(2).
(3)
Required response from the
insurer . When notified by the director that additional amounts may be
due to the worker as a penalty under this rule:
(a) The insurer must respond in writing to
the division :
(A) The response must include a
reason for the delay, and any additional information or documentation requested
by the director ;
(B) The response
must be mailed or delivered to the division within 14 days of the mailing date
of the director 's inquiry letter; and
(C) Copies of the response, including any
attachments, must be simultaneously sent to the worker and the worker's
attorney, if any;
(b) If
the insurer fails to meet the requirements of this section, the director may
assess a civil penalty under OAR
436-060-0200.
(4)
Jurisdiction over
proceedings. The director has exclusive jurisdiction when the assessment
and payment of penalties and attorney fees described in ORS
656.262(11) is
the sole issue of the proceedings between the parties.
(a) If the director receives a request for
penalties and attorney fees under this rule, and is aware that a hearing has
been requested before the board on other issues, the director may transfer the
request to the board . Factors the director will consider in determining whether
to transfer the request include, but are not limited to, the status of the
hearing and the date set for the hearing. The determination of whether to
transfer a request to the board is solely within the authority of the
director .
(b) If the director has
not been made aware of the proceeding before the board and issues a penalty
order that becomes final, the director 's penalty will stand.
(5)
Timely payment of
penalties. Penalties ordered under this rule must be paid to the worker
no later than the 30th day after the date of the order, unless the order is
appealed. If the order is appealed and later upheld, the penalty will be due
within 14 days of the date the order upholding the penalty becomes final. If
the insurer does not pay penalties in a timely manner the insurer will be
subject to civil penalties under OAR
436-060-0200.
(6)
Dispute resolution. Disputes
regarding unreasonable delay or unreasonable refusal to pay compensation,
attorney fees or costs, or unreasonable delay in acceptance or denial of a
claim may be resolved by the parties.
(a) In
cases where the director has exclusive jurisdiction under section (4) of this
rule, and the violations occurred within the last 180 days as described in
subsection (2)(c) of this rule, then the parties must submit a stipulation to
the division for approval. The stipulation must specify:
(A) The benefits, attorney fees, or costs
delayed and the amounts;
(B) The
time periods involved;
(C) If
applicable, the name of the medical providers and the dates of services
relating to medical bills;
(D) The
amount of the penalty not to exceed 25 percent of the amounts then due under
ORS 656.262(11)(a);
and
(E) The attorney fees, if
applicable.
(b) Any other
agreements between the parties to pay a penalty or attorney fee must have a
stipulation approved by the director to be acknowledged as a violation as it
applies to the matrix in Appendix "B" of these rules. [See attached
table.]
(c) Payment of a penalty
due under this section is due within 14 days after the date the director
approves the stipulation, unless otherwise stated in the stipulation. If the
insurer does not pay penalties in a timely manner the insurer will be subject
to civil penalties under OAR
436-060-0200.
Notes
Appendices referenced are not included in rule text. Click here for PDF copy of appendices.
Statutory/Other Authority: ORS 656.262(11), 656.704, 656.726(4) & 656.745
Statutes/Other Implemented: ORS 656.262(11), 656.704 & 656.745
State regulations are updated quarterly; we currently have two versions available. Below is a comparison between our most recent version and the prior quarterly release. More comparison features will be added as we have more versions to compare.
No prior version found.